60 lines
1.7 KiB
PHP
60 lines
1.7 KiB
PHP
<?php include("share/header.php"); ?>
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<h1>Vous voulez venir découvrir linux ? participer ? Inscrivez-vous !</h1>
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<form action="register.php" method="post" >
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<table width="100%">
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<tbody>
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<tr>
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<td align="right">Nom : </td><td><input type="text" name="nom" size="30" />
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</td>
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</tr>
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<tr>
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<td align="right">Prénom : </td><td><input type="text" name="prenom" size="30" />
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</td>
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</tr>
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<tr>
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<td align="right">E-mail : </td><td><input type="text" name="email" size="30" />
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</td>
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</tr>
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<tr>
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<td align="right">Horaire souhaité :</td>
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<td>
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<select name="horaire">
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<option value="10h-12h">10h-12h</option>
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<option value="11h-13h">11h-13h</option>
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<option value="12h-14h">12h-14h</option>
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<option value="13h-15h">13h-15h</option>
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<option value="14h-16h">14h-16h</option>
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<option value="15h-17h">15h-17h</option>
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<option value="chaispas">Je ne sais pas</option>
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</select>
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</td>
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</tr>
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<tr>
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<td align="right">Distribution envisagée :</td>
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<td>
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<select name="distrib">
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<option value="Debian">Debian</option>
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<option value="Ubuntu">Ubuntu</option>
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<option value="Mandrake">Mandrake</option>
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<option value="Fedora">Fedora</option>
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<option value="Suse">Suse</option>
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<option value="Autre">Autre</option>
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<option value="chaispas">Je ne sais pas</option>
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</select>
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</td>
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</tr>
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<tr>
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<td align="right">Configuration Matérielle : </td>
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<td><textarea rows="5" cols="60" name="config"></textarea></td></tr>
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<tr><td align="right">Remarques : </td><td>
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<textarea rows="5" cols="60" name="rmq"></textarea>
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</td>
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</tr>
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<tr><td></td><td><input type="submit" name="boutok" value="envoyer"/></td></tr>
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</tbody>
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</table>
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</form>
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<?php include("share/footer.php"); ?>
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